Central Asia: Thinking about Family Planning

Worldwide, 222 million women want to delay or avoid pregnancy but have no access to modern contraceptives. If they did, this would help prevent 21 million unwanted pregnancies; 79,000 maternal deaths and 1.1 million infant deaths.

Widening access to reproductive health, including family planning, is one of the eight Millennium Development Goals agreed on by the international community to be achieved by 2015. It reduces maternal and child mortality, prevents sexually transmitted infections, including HIV/AIDS, and allows people to have responsible, satisfying and safe sexual and reproductive lives.

Family planning in particular gives individuals and couples the means to decide freely and responsibly if, when and how often to have children. It is key to ensuring that women benefit from good reproductive health and enjoy a life of opportunities. It also allows individuals and couples to anticipate and attain their desired number of children, and to achieve healthy spacing and timing of their births.

When women – and especially adolescent girls – are empowered to make their own decisions over when and whether to become pregnant, fewer mothers and fewer babies die during childbirth and fewer women recourse to abortion.

Given that July 11 marked World Population Day, now is an appropriate time to remind ourselves that ensuring full access to voluntary family planning means that we care about the health, well-being and opportunities of women and girls. The United Nations Population Fund (UNFPA) has for decades been working with governments around the world to ensure that universal access to reproductive health, including voluntary family planning and maternal health, become a reality for all.

In my capacity as head of the UNFPA regional office for Eastern Europe and Central Asia, I am well aware of the specific challenges to reproductive health in this part of the world. Full access to family planning services is of critical importance in this region, where abortion is frequent and often used instead of family planning. While abortion rates have declined over the last years, they are still high. According to the latest data presented by the World Health Organization, almost 500 abortions are counted in region per 1,000 live births.

A high rate of abortions often reflects an unmet need for family planning services and lack of access to information about these services. Women turn to abortion simply because contraceptive options, or information about potential options, are not readily available at the right time. Once quality family planning services are made available to women, they tend to embrace family planning methods at high rates.

While population is still on the rise in many parts of the world, Eastern Europe and Central Asia as a region is experiencing an overall population decline. At 0.3 percent on average, the region has the lowest population growth rate in the world.

Except for Turkey, Kosovo and the countries of Central Asia, all other countries in the region have fertility rates well below the level required to replace generations. Combined with high male mortality and high out-migration this leads to rapidly declining or negative population growth rates. These demographic concerns have prompted many governments in the region to embrace “pro-natalist” policies aimed at increasing fertility rates, or the number of children a woman will have during her lifetime.

There is widespread debate among experts about the effectiveness of policies that are intended to reverse low levels of fertility. What we know is that, in many countries in the region, many women want to have more children than they actually have. Encouraging child bearing should be achieved by creating the necessary health, social and economic conditions for women to have the number of children they want.

A favorable environment for child bearing is usually created by a combination of policies, such as easing some of the burdens that mothers face in the workforce, increasing the availability of day care facilities for children, or adopting family-friendly policies that allow women and men to balance work and family.

Policies in low-fertility contexts also need to address the causes of infertility in men and women. Infertility is generally caused by postponing conception and child bearing to later ages, or by preventable diseases, including infections and cervical cancer.

Most population policies take effect slowly, over generations. Governments can therefore be tempted to take initiatives that are seen to have immediate effects, such as reducing access to contraception, rewarding women who have more children or revising abortion policies. But we know from past experience that these policies are usually not sustainable, they tend to violate women’s rights and pose great risks to their lives.

The experience of Romania in the 1970’s and 1980’s should serve as a warning. In an attempt to increase population size, the government adopted draconian anti-abortion regulations and a total ban on contraceptives. These interventions led to an initial success in boosting birth rates. However, this proved to be short-lived and the country ended the ‘80s with soaring maternal and infant mortality rates and birthrates that were only a small fraction higher than those in neighboring countries.

Let’s face it: for many women and adolescent girls in the region, family planning is still not accessible or affordable. Some are unable to use it because of social or cultural attitudes, or are unwilling to use it for ill-informed fears of their side effects and the many myths surrounding contraception. Due to inadequate infrastructure and lack of services, too many women have abortions or repeat abortions instead of relying on family planning services and counseling.

In order to take advantage of the full potential of women and men in the development of their nations, they must be able to plan their lives and families. And governments have an obligation to support them, by respecting their rights and being responsive to their needs. Universal access to reproductive health plays a key role in this endeavor.

Editor's note:

Werner Haug is the UNFPA’s Regional Director for Eastern Europe and Central Asia.